GOALS, OBJECTIVES, CORE CURRICULUM AND SUGGESTED READING .

GOALS, OBJECTIVES, CORE CURRICULUM ANDSUGGESTED READING LIST FOR PEDIATRIC IMAGINGThe foundation of the DHMC Radiology resident training in Pediatric Radiology is a 3month rotation at Boston Children’s Hospital, one of the premier Pediatric RadiologyDepartments in the world. This 3 month experience which occurs during the PGY3/R2year is supplemented by Pediatric imaging cases on all subspecialty rotations at DHMCover all four years of residency and a series of Pediatric Radiology Core didactic teachingsessions that rotate on a two year basis. The Dartmouth Hitchcock Medical Center ishome to CHaD, the Children’s Hospital at Dartmouth, has a Pediatric residency program,is a Level 1 Pediatric Trauma Center and is home to the Norris Cotton Cancer Center, theleading cancer center in Northern New England.The following are the Goals and Objectives for the 3 month residentrotation at Boston Children’s Hospital (per ILDREN’S HOSPITAL PEDIATRIC RADIOLOGY ROTATIONGOALS, OBJECTIVES AND EVALUATION PROGRAMBOSTON, MAThe three-month rotation for diagnostic radiology residents at Children's Hospital has thefollowing goals and objectives: To familiarize residents with the diagnostic imaging of infants and children, and toemphasize that infants are not simply small children, and children are not simplysmall adults. To develop comfort with and skill in talking to children and their parents. The rotation is heavily weighted toward general diagnostic radiology so that theresident will learn to become familiar with the concepts behind and the imagingfindings in infants and children with the most common as well as the mostcommonly overlooked conditions. These include but are not limited to thefollowing, arranged by organ system and age:Chest and AirwayReactive airway disease; pneumonia (including “round pneumonia”); foreign bodies;cystic fibrosis; congenital cystic adenomatoid malformation; lobar emphysema; and anapproach to the lucent and the opaque hemithorax; and airway emergencies.MusculoskeletalGrowth plate injuries and the Salter classification; buckle (torus) fractures; normalvariants in the growing skeleton that can mimic disease; slipped capital femoralepiphysis; Legg-Perthes disease; scoliosis; signs of inflected trauma; common fractures(including supracondylar, ankle, and toddler’s).Gastrointestinal

Intussusception and its non-operative treatment; malrotation; meconium ileus and othercauses of bowel obstruction in the very young (and meconium ileus equivalent in cysticfibrosis); pyloric stenosis; inflammatory bowel disease; gastroesophageal reflux disease;acquired small bowel obstruction in older infants and children.UroradiologyUrinary tract infection/vesicoureteral reflux and management guidelines thereof,including imaging (ultrasonography, voiding cystourethrography, radionuclidecystography, cortical scintigraphy); congenital anomalies presenting as prenatallydiagnosed hydronephrosis, including UPJ obstruction, primary megaureter, duplexkidney with ectopic ureterocele or obstructed ectopic ureter, posterior urethral valves;ectopic ureters in girls with wetting; neurogenic dysfunction of the bladder associatedwith myelomeningocele, for example.NeonataologyHyaline membrane disease; bronchopulmonary dysplasia; meconium aspiration;pulmonary interstitial emphysema; effect of surfactant on radiographic and clinicalpatterns; ECMO; necrotizing enterocolitis.NeuroradiologyIndications for and performance of emergency head CT, usually for trauma with ability torecognize epidural hematoma, subdural hematoma, contusion, etc.; recognition ofhydrocephalus and its treatment with shunting, including evaluation of ventricular shunts;indications for emergency MRI, cerebral angiography, and myelography; indications forand performance of neck CT, usually for infection.The residents will also be exposed to an approach to the various imaging modalities asthey are used in infants and children, including nuclear medicine, ultrasonography,computed tomography, magnetic resonance imaging, interventional radiology andconventional fluoroscopy.Residents assigned to Children’s Hospital will be permitted to attend lectures atChildren’s Hospital according to their schedule Monday through Friday. The residentswill participate in general diagnostic radiology activities under the supervision of theattending staff at Children’s Hospital. The Resident will take part in the on-call schedulefor pediatric radiology as assigned. They are evaluated by a formal evaluation process atthe end of their assigned Children’s Hospital rotation. These evaluations are based onthe trainee’s performance and technical competency and will be reported to theiraffiliating Program Director.PEDIATRICS ROTATION AT BCHPatient CareResidents must be able to provide patient care that is compassionate, appropriate, andeffective for the diagnosis and treatment of health problems. Residents are expected to:

communicate effectively and demonstrate caring and respectful behaviorswhen interacting with patients and their familiesgather essential and accurate medical and radiologic history pertinent to theradiographic examination performedwork with health care professionals, including those from other disciplines, toprovide patient-focused carerecognize urgent, emergent, and critical clinical situations and provide care in atimely and appropriate fashionunderstand and respect the principles of minimizing radiation exposure tochildrenunderstand the risks and issues involved in providing or arranging pediatricsedationAssessmentFaculty evaluations360 degree evaluationsACR In-Service ExamABR ExamProcedure LogLearning PortfolioMedical KnowledgeResidents must demonstrate knowledge about established and evolving biomedical,clinical, and cognate sciences and the application of this knowledge to patient care.During this rotation, residents are expected to: learn the normal chest, abdominal, and developmental musculoskeletal plainfilm anatomylearn to interpret plain radiographs of the chest, abdomen, and musculoskeletalsystemlearn the radiographic manifestations of common disease entities seen in theabove studieslearn the timing of growth plate development and fusion in order to interpretfilms on childrenPractice-Based Learning and ImprovementResidents must be able to investigate and evaluate their patient care practices, appraiseand assimilate scientific evidence, and improve their patient care practices. Residents areexpected to: apply knowledge of study designs and statistical methods to the appraisal ofclinical studies and other information on the diagnostic effectiveness of plainfilms and their role in the clinical care of the patient

use information technology to manage information, access on-line medicalinformation; and support their own educationfacilitate the learning of students and other health care professionalslocate, appraise, and assimilate evidence from scientific studiesInterpersonal and Communication SkillsResidents must be able to demonstrate interpersonal and communication skills that resultin effective information exchange with technologists, referring physicians, and othermedical personnel. Residents are expected to: work professionally and effectively with the technologistscommunicate with the referring clinician in order to optimize and prioritize theperformance of studies on childrencommunicate findings effectively with the referring clinicianscommunicate and document the communication of critical findings with theappropriate medical personnel in a timely fashioncommunicate effectively with pediatric patients, their families and theircaregiversProfessionalismResidents must demonstrate a commitment to carrying out professional responsibilities,adherence to ethical principles, and sensitivity to a diverse patient and professionalpopulation. Residents are expected to demonstrate respect, compassion, and integrity demonstrate a commitment to excellence and on-going professionaldevelopment demonstrate a commitment to ethical principles pertaining to provision orwithholding of clinical care, confidentiality of patient information, andbusiness practices demonstrate sensitivity and responsiveness to patients’ culture, age, gender,and disabilitiesSystems-Based PracticeResidents must demonstrate an awareness of and responsiveness to the larger context andsystem of health care and the ability to effectively call on system resources to providecare that is of optimal value. Residents are expected to: understand how their professional practice affects other health careprofessionals, the health care organization and the larger society, and howthese elements affect their own practiceassist referring clinicians in providing cost-effective health carepractice cost-effective health care and resource allocation that does notcompromise quality of -------------------------------------------

PEDIATRIC RADIOLOGY CORE CURRICULUM at DHMCThe Pediatric Radiology Core Curriculum at DHMC is linked to related units in theCleveland Clinic comet on-line Pediatric Radiology educational nmenu.asp). Appropriate units are assignedprior to the resident conference, allowing the conference to be more interactive and casebased. The units to be reviewed prior to each teaching session are listed below:SESSION 1: NEONATAL CHEST (SKS)-Neonatal Chest unitSESSION 2: PEDIATRIC CHEST (SKS)-Esophageal Atresia unit-Childhood pneumonia unit-Bronchopulmonary foregut malformation unitSESSION 3: PEDIATRIC GI EMERGENCIES (SKS) to be given duringelectivesummer student-Hypertrophic Pyloric Stenosis unit-Malrotation and Midgut Volvulus unit-Intussusception unitSESSION 4: PEDIATRIC GI (SKS)-Congenital duodenal obstruction unit-Jejunal and ileal atresia unit-Neonatal low bowel obstruction unitSESSIONS 5 and 6: CONGENITAL GU DEVELOPMENTAL ANOMALIES Part 1 and 2. (SKS)-Multicystic Dysplastic Kidney unit-Duplicated collecting systems unitSESSION 7: PEDIATRIC GU (TV) to be given early in academic year-Posterior Urethral Valves unit-Vesicoureteral Reflux unit

SESSION 8: PEDIATRIC NEOPLASMS (TV)-Neuroblastoma, Ganglioneuroblastoma, Ganglioneuroma unit-Wilms and Other Renal Tumors unitSESSION 9: CHILD ABUSE (TV)-Child Abuse: Skeletal Trauma unitSESSION 10: PEDIATRIC ULTRASOUND (TV)-Scrotal torsion unit-Scrotal neoplasms unit-Newborn cranial ultrasound unit-Spine: The sacral dimple unitSESSION 11: PEDIATRIC INTERESTING CASES (TV)READING LISTA. Selected articles and additional texts as per SS (Dr. Sargent) and TV(Dr. Vaccaro)1. Pause and Pulse: Ten Steps That Help Manage Radiation Dose DuringPediatric Fluoroscopy, Marta Hernanz-Schulman, Marilyn J. Goske,Ishtiaq H. Bercha, Keith Strauss. AJR; August 2011 197:475-481;doi:10.2214/AJR.10.6122B. Texts:1. Fundamentals of Pediatric Imaging, by Donnelly, Lane. W.B.Saunders2. Pediatric Radiology: The requisites, 2nd Edition by Hans Blickman,Mosby publishersC. Reference Texts:1. Imaging of the Newborn, Infant and Young Child, 4th Ed., Leonard E.Swischuck, Williams and Wilkins publishers2. Caffey’s Pediatric Diagnostic Imaging, Elsevier, Philadelphia, PA.3. Practical Pediatric Imaging, 3rd Edition by Kirks, D. Lippincott-Raven4. Pediatric Ultrasound Imaging, Marilyn Siegel, Raven PressUpdated May 2016

year is supplemented by Pediatric imaging cases on all subspecialty rotations at DHMC over all four years of residency and a series of Pediatric Radiology Core didactic teaching sessions that rotate on a two year basis. The Dartmouth Hitchcock Medical Center is home to CHaD, the Children’s Hospital at Dartmouth, has a Pediatric residency program,